Association between preconception serum lipid concentrations and treatment outcomes in women with PCOS who underwent ovulation induction

Abstract

Research questionWhat is the association between preconception serum lipid concentrations and reproductive outcomes after ovulation induction in women with polycystic ovary syndrome (PCOS)? DesignA secondary analysis of a randomized controlled trial with 1000 PCOS women undergoing ovulation induction with clomiphene with or without acupuncture. Preconception serum total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, apolipoprotein A1 (ApoA1), apolipoprotein B (ApoB) were measured. Outcomes were ovulation, conception, pregnancy, live birth and miscarriage. Logistic regression was used to calculate odds ratios (OR) with 95% confidence intervals (CI). ResultsIn total, 780 women ovulated; 320 women achieved conception, 218 had a clinical pregnancy, 205 had a live birth and 115 had a miscarriage. Serum lipid concentrations per one unit increment were independently associated with reproductive outcomes after controlling for confounders. Increasing LDL-C (OR 0.79, 95% CI 0.63–0.99) was independently associated with a lower chance of ovulation. Increasing total cholesterol (OR 0.76, 95% CI 0.62–0.92), LDL-C (OR 0.73, 95% CI 0.57–0.93), triglycerides (OR 0.74, 95% CI 0.58–0.95) and ApoB (OR 0.34, 95% CI 0.16–0.74) were independently associated with a lower chance of clinical pregnancy. Increased total cholesterol (OR 0.78, 95% CI 0.64–0.96), LDL-C (OR 0.77, 95% CI 0.60–0.99), triglycerides (OR 0.76, 95% CI 0.59–0.96) and ApoB (OR 0.39, 95% CI 0.18–0.86) were independently associated with a lower chance of live birth. Furthermore, increased total cholesterol (OR 1.43, 95% CI 1.06–1.93), LDL-C (OR 1.51, 95% CI 1.04–2.19) and ApoB (OR 3.82, 95% CI 1.17–12.41) were independently associated with a higher chance of miscarriage. ConclusionsIncreased serum lipids were negatively associated with the reproductive outcomes of PCOS women undergoing ovulation induction with clomiphene with or without acupuncture.